Intraluminal catheter with expandable tubular open-walled element

ABSTRACT

An intraluminal catheter having an expandable tubular open-walled element for immobilizing at least part of the catheter within a patient&#39;s body lumen, generally comprising an elongated shaft and a tubular open-walled element secured to the shaft, wherein the tubular open-walled element is at least in part expandable from an unexpanded diameter to a larger diameter expanded diameter within the body lumen. The expanded diameter configuration is configured to contact a wall defining the body lumen and thereby releasably secure at least part of the catheter within the body lumen. A cannula member, used for delivering or removing fluids from the body lumen, can be positioned in one or more optimal perfusion locations within the body lumen during use, independent of the secured site. When occlusion of the axial flow is necessary, an optional occluding member may be reversibly deployed so that it expands inside and against the expanded tubular open-walled element . The optimal occlusion site can also be chosen independently of the secured site.

BACKGROUND OF THE INVENTION

[0001] This invention relates to the field of intraluminal catheters,and more particularly to an intraluminal catheter for cannulation of apatient's body lumen for delivering or draining fluids.

[0002] The use of intraluminal catheters in a patient's body lumen oftenrequires securing the catheter so that its distal or operative end is ata desired location inside the body lumen. Means for securing thecatheter within a body lumen include purse string sutures, and balloons.When using purse strings, the vessel is usually clamped to stop the flowof fluid inside it. The clamping procedure makes purse stringscomplicated to use in percutaneous or minimally invasive surgicaltechniques. Moreover, the clamped site, which must be in close proximityto the cannulation site, may cause trauma to the vessel wall ordislodging of calcium debris or plaque within the vessel.

[0003] Use of a balloon on the catheter to secure the catheter withinthe patient's body lumen may also cause trauma to the lumen, due to theinflation pressure inside the balloon necessary to hold the catheter inplace. Moreover, the retention balloon must have a large surface area incontact with the body lumen, for there to be sufficient frictionalresistance to prevent catheter displacement. As a result, the largeretention balloon is likely to block the opening to nearby branch lumenswhich intersect the cannulated lumen. Additionally, by using a balloonto both secure the catheter within the body lumen and occlude the lumen,the occluder cannot be displaced relative to the secured site to findthe optimum occlusion site. Moreover, because the inflated balloon doesnot allow for flow of fluid around or across the balloon, the cannulatedlumen is obstructed by the balloon, and the catheter cannot be used inprocedures where occlusion of the vessel is not desirable.

[0004] In some procedures involving cannulae, it may be desirable toocclude the cannulated vessel. For example, during heart surgery, themyocardium is protected by a technique known as retroperfusion in whichcardioplegic solution is infused in a retrograde manner (through veinsopposite the normal blood flow direction) into the coronary anatomy viathe coronary sinus. Retroperfusion requires occlusion of the coronaryanatomy to prevent back flow of the cardioplegic solution into the rightatrium. On current retroplegia cannulae designs, a balloon is used toretain the cannula in place inside the patient, and also serves toocclude the cannulated vessel. The retention balloon of the currentcannulae inflates inside the ostium downstream of the middle cardiacvein (serving the right ventricular territory), in the space between themiddle cardiac vein and the veins coming from the left ventricle, andthe solution is infused distally to the balloon. Because the spaceupstream of the middle cardiac vein between the ostium and the middlecardiac vein is too small to contain the balloon, the middle cardiacvein must be excluded from the perfusion. Consequently, the rightventricle is left unprotected during heart surgery. Therefore, althoughvessel occlusion may be required in a procedure, use of the inflatedretention balloon to occlude the vessel is disadvantageous.

[0005] Attempts to improve the catheter design to minimize theobstruction the branch lumens have included shortening the retentionballoon. Although the use of protuberances or ridges on the balloonsurface to improve the frictional contact has been suggested, theshortened balloon may provide insufficient frictional contact with thelumen surface. Fixation balloons made of an open open-walled elementmaterial are also known, wherein fluid is free to flow through theopen-walled element.

[0006] What has been needed and heretofore unavailable is anintraluminal catheter with a securing member which allows for the freeflow of fluid around and across it, and with a cannula and an occluderthat can be positioned independently the secured site. The presentinvention satisfies these and other needs.

SUMMARY OF THE INVENTION

[0007] The invention is directed to an intraluminal catheter having anexpandable tubular open-walled element for securing at least part of thecatheter within a patient's body lumen. The intraluminal catheter of theinvention generally comprises an elongated shaft and a tubularopen-walled element secured to the shaft, wherein the tubularopen-walled element is at least in part expandable from an unexpandeddiameter configuration to a larger diameter expanded diameterconfiguration within the body lumen. Upon expansion, the tubularopen-walled element is configured to contact a wall defining the bodylumen and thereby secure at least part of the catheter within the bodylumen. A cannula member, used for delivering or removing fluids from thebody lumen, is slidably disposed within a lumen of the shaft and a lumenof the tubular open-walled element.

[0008] In one embodiment of the invention, the catheter shaft comprisesan outer tubular member and an inner tubular member slidably disposed ina lumen of the outer tubular member. The cannula member is releasablysecured to the inner tubular member, and is disposed in a lumen therein.The tubular open-walled element is secured to the inner tubular member,so that when the cannula member is secured to the inner tubular member,the cannula member can be secured within the body lumen by the expandedopen-walled element. However, when the cannula member is released fromthe inner tubular member, it is longitudinally displaceable relative tothe inner tubular member. Therefore, the cannula member can bepositioned in one or more optimal perfusion locations within the bodylumen during use, independent of the secured site, and then releasablylocked into position on the secured inner tubular member.

[0009] In one embodiment of the invention, an occluding member isslidably disposed a lumen of the shaft. In a preferred embodiment, theoccluding member is on the cannula member. However, it can be secured tothe inner lumen of the tubular open-walled element instead. Whenocclusion of the axial flow is necessary, the occluding member may bereversibly deployed so that it expands inside and against the expandedtubular open-walled element. Because the cannula can be moved freely inthe axial direction, the occluding member secured thereto can bepositioned in the desired site by pushing or pulling the cannula. Theoptimal occlusion site can be chosen independently of the secured site,and the occluder and cannula secured within the body lumen by beingreleasably secured to the secured inner tubular member. The securedcannula member can then be used to deliver or remove fluid from an areaof the body lumen sectioned off by the occluding member.

[0010] However, where such displacement of the occluding member relativeto the tubular open-walled element is not required, the inner tubularmember is omitted. Thus, in one embodiment, the catheter comprises anelongated shaft, and a cannula member having the tubular open-walledelement and the occluding member secured thereto, with the cannulamember slidably disposed in the lumen of the elongated shaft.

[0011] The open-walled element material allows fluid to flow freelyaround and across the open-walled element, and generally comprises amesh structure or a permeable material. Because the open-walled elementdoes not restrict fluid flow, it can be deployed over lateral branchesintersecting the patient's body lumen without obstructing the lateralbranches or the coaxial flow around the cannula. Unlike fixationballoons which do obstruct flow within the body lumen, the length of theopen-walled element does not have to be minimized to avoid obstructingthe flow in the body lumen and side branches. Therefore, the open-walledelement can be as long as necessary to obtain good support, andminimizes pressure on the vessel wall. The open-walled element may bemade of a variety of expandable materials including but not limited topolymeric materials, stainless steel, a NiTi alloy, a pseudoelastic NiTialloy having a phase transition temperature above body temperature, acobalt, nickel, molybdenum, and chromium alloy such as MP35N.

[0012] In a presently preferred embodiment of the invention, theopen-walled element is self expanding, so that the open-walled elementassumes an unexpanded configuration in response to radially compressingforce, and the expanded diameter configuration when the radiallycompressing force is removed. However, the open-walled element may beconfigured to expand in response to a radially expanding force.

[0013] One aspect of the invention involves a method of performing amedical procedure using the catheter of the invention. The methodcomprises positioning the catheter in a desired location within thepatient's body lumen, expanding at least a portion of the cathetertubular open-walled element to contact a wall defining the body lumenand secure the catheter therein, and performing the medical procedure.The catheter is released from the body lumen following the medicalprocedure by collapsing the open-walled element into the unexpandeddiameter configuration.

[0014] A presently preferred embodiment of the method of the inventioninvolves performing a perfusion procedure within the patient's bodylumen, including but not limited to retroperfusion of the heart,perfusion of the ascending aorta, and isolation of a dissection of thedescending aorta. For example, in retroperfusion of the heart, using thepresent invention, the tubular open-walled element can be left outsidethe coronary sinus ostium, inside the right atrium, and the occludingmember can be advanced into the sinus until achieving its closure.Therefore, unlike available retroplegia cannulae, the catheter of theinvention allows retroperfusion of the middle cardiac vein, whichprovides full retroperfusion of the heart, including the rightventricle, otherwise left unprotected with current cannula designs.

[0015] The catheter of the invention, having an expandable open-walledelement, allows for securing the catheter within a patient's body lumenwithout occluding side branches intersecting the body lumen. In oneembodiment of the invention, the catheter provides for cannulation ofthe body lumen, wherein the cannula can be displaced relative to thesecured site to choose the optimal perfusion site. In another embodimentof the invention, the catheter provides for occlusion of the body lumen,and displacement of the occluding member relative to the secured site sothat the optimal occlusion site can be selected. These and otheradvantages of the invention will become apparent from the followingdetailed description of the invention and accompanying exemplaryfigures.

BRIEF DESCRIPTION OF THE DRAWINGS

[0016]FIG. 1 is an elevational view partially in section of anintraluminal catheter which embodies features of the invention.

[0017] FIGS. 2-4 are transverse cross-sectional views of the cathetershown in FIG. 1 taken along lines 2-2, 3-3, and 4-4, respectively.

[0018]FIG. 5 is an elevational view partially in section of theintraluminal catheter shown in FIG. 1, within a body lumen.

[0019]FIG. 6 is a transverse cross-sectional view of the catheter shownin FIG. 5 taken along lines 6-6.

[0020]FIG. 7 is an elevational view partially in section of anintraluminal catheter which embodies features of the invention.

[0021]FIG. 8 is a transverse cross-sectional view of the catheter shownin FIG. 7 taken along lines 8-8.

[0022]FIG. 9 illustrates an intraluminal catheter which embodiesfeatures of the invention disposed in part within a coronary sinus, forretroperfusion of the heart.

[0023]FIG. 10 illustrates an intraluminal catheter which embodiesfeatures of the invention disposed in the ascending aorta, by dissectionof the ascending aorta.

[0024]FIG. 11 illustrates an intraluminal catheter which embodiesfeatures of the invention disposed within the ascending aorta, bypercutaneous introduction of the catheter.

[0025]FIG. 12 illustrates an intraluminal catheter which embodiesfeatures of the invention disposed within the ascending aorta, bypercutaneous introduction of the catheter.

[0026]FIG. 13 illustrates an intraluminal catheter which embodiesfeatures of the invention disposed within the descending aortapercutaneously.

DETAILED DESCRIPTION OF THE INVENTION

[0027] In the embodiment illustrated in FIG. 1, the intraluminalcatheter 10 of the invention comprises an elongated shaft 11, a tubularopen-walled element 12 secured to the shaft 11, an occluding member 13on the shaft for reversibly occluding a body lumen, and an adapter 14mounted on a proximal end of the shaft 11. The shaft comprises an outertubular member 16, and inner tubular member 17. The outer tubular member16 has a proximal end and a distal end, a port 19 on the distal end, anda lumen 20 extending therein. The inner tubular member 17 also has aproximal end and a distal end, a port 21 on the distal end, and a lumen22 extending therein. The inner tubular member 17 is slidably disposedwithin the lumen 20 of the outer tubular member 16, and cannula member18 is slidably disposed within the lumen 22 of the inner tubular member17 and a lumen of the tubular open-walled element 12. FIGS. 2-4illustrate transverse cross-sections of the catheter 10 shown in FIG. 1taken along lines 2-2, 3-3, and 4-4 respectively.

[0028] The tubular open-walled element 12 has proximal and distal ends,a port 23 on the distal end, and a lumen 24. The open-walled element 12is provided with openings 25 allowing for flow of fluids across a wallof the element 12. The open-walled element 12 proximal end is secured tothe distal end of the inner tubular member 17 and the open-walledelement 12 distal end is left unsecured. The tubular open-walled element12 is at least in part expandable to an expanded diameter configurationwithin a body lumen to contact a wall defining the body lumen andthereby releasably secure the catheter within the body lumen. In FIG. 1,the tubular open-walled element 12 is illustrated in an unexpandeddiameter configuration. FIG. 5, which shows the catheter 10 within abody lumen 26, illustrates an expanded diameter configuration of thetubular open-walled element 12 in contact with the body lumen wall. FIG.6 illustrates a transverse cross section of the catheter 10 shown inFIG. 5 taken along lines 6-6. The tubular open-walled element 12 may beself-expanding, where it assumes the unexpanded diameter configurationin response to the radially compressive force that is applied when thetubular open-walled element 12 is within the lumen 20 of the outertubular member 16, and assumes the expanded diameter configuration whenthe tubular open-walled element 12 extends distally of the distal end ofthe outer tubular member 16 so that the radially compressive force isremoved. To expand a tubular open-walled element 12 that is notself-expanding, a radially expansive force, as is produced by inflationof a balloon (not shown) disposed within the tubular open-walled elementlumen, would be applied.

[0029] In FIG. 1, the occluding member 13 located on the cannula member18 is shown within the lumen of the outer tubular member, and in FIG. 5it is shown extended beyond the distal end of the outer tubular member.As best illustrated in FIGS. 1 and 5, when the occluding member 13extends distally of the distal end of the outer tubular member, theoccluding member reversibly occludes the patient's body lumen. In theembodiments illustrated, the occluding member comprises a reversiblyexpandable protruding collar. However, other suitable occluders exist,including but not limited to, inflatable members, occluding coils, andflexible collapsible membranes. The protruding collar may be concave orconvex relative to the distal end of the cannula member, and the flowcan be stopped in either direction according to the orientation giventhe protruding collar. In another embodiment, illustrated in FIG. 12 theoccluding member 13 is secured to the tubular open-walled element 12, sothat securing the cannula in the patient's body lumen and occlusion ofthe body lumen are accomplished in one step. In this embodiment, theoccluding member 13 cannot be displaced relative to the secured site inthe body lumen. Thus, expansion of the tubular open-walled element 12also causes the occluding member 13 to occlude the patient's body lumen,and retraction of the tubular open-walled element 12 collapses theoccluding member 13. In the embodiment illustrated in FIG. 12, theoccluding member 13 comprises a flexible collapsible membrane.

[0030] In another embodiment of the invention the occluding member 13 isomitted, so that the catheter 10 comprises a shaft 11 comprising outer16 and inner 17 tubular members, and a cannula member 18, with anexpandable tubular open-walled element 12 on the inner tubular member17.

[0031]FIG. 7 illustrates another embodiment of the invention, similar tothe embodiment illustrated in FIG. 1 except that the inner tubularmember is omitted. The catheter 28 comprises an elongated outer tubularmember 16 and a cannula member 18 slidably disposed therein. The tubularopen-walled element 12 and occluding member 13 are secured to a distalsection of the cannula member 18, and are therefore not longitudinallydisplaceable relative to one another. FIG. 8 illustrates a transversecross section of the catheter shown in FIG. 7 taken along lines 8-8.

[0032] The length of the intraluminal catheter 10/28 for aortic use maybe about 20 cm to about 130 cm, and is typically about 40 cm. The innertubular member 17 and cannula member 18 are sufficiently long to extendout the proximal and distal ends of the outer tubular member. The outertubular member 16 has an outer diameter (OD) of about 4.0 mm to about 15mm, and an inner diameter (ID) of about 3.5 mm to about 14 mm. Thelength of the outer tubular member is about 16 cm to about 125 cm. Theinner tubular member 17 has an OD of about 3.5 mm to about 14 mm, and anID of about 3.30 mm to about 13.4 mm. The length of the inner tubularmember 17, including the open-walled element 12 is about 15 cm to about124 cm. The cannula member 18 has an OD of about 3.3 mm to about 13.4mm, and an ID of about 3 mm to about 13 mm. The length of the cannulamember is about 16 cm to about 135 cm. However, the dimensions of theintraluminal catheter 10/28 will differ depending on the application, asfor example, in intraarterial use where the tubular members would havean OD of about 0.5 mm to about 7 mm, and an ID of about 0.3 mm to about6 mm. The occluding member 13 may be about 7 cm to about 20 cm from thedistal extremity of the cannula member 18, typically about 15 cm for theembodiment illustrated in FIG. 1.

[0033] The outer tubular member 16, inner tubular member 17, and cannulamember 18 may be releasably secured together, so that the members can belongitudinally displaced relative to one another to properly positionthe tubular open-walled element, occluding member, and cannula member,and then secured together so that the expanded open-walled element isnot limited to releasably securing the member on which it is located.Such members may be secured together by a variety of suitable means,including but not limited to clips, outer sheaths, clamps, expandablewashers, and the like, on the proximal end of the catheter.

[0034] The cannula member 18 is used for delivering or removing fluidsfrom the body lumen and is provided with at least one perfusion port 27in fluid communication with the cannula lumen 24. In the embodimentsillustrated in FIGS. 1-7, perfusion ports 27 are located on the distalend of the cannula member 17. FIG. 13 illustrates another embodiment,having distal perfusion ports 43 on the distal end of the cannula member17, and proximal perfusion ports 41 at a location spaced proximally tothe distal perfusion ports 43. The perfusion ports may be locatedproximally or distally to the occluding member 13.

[0035] Another aspect of the invention involves a method of performing amedical procedure using the intraluminal catheter 10 of the invention,the method comprising positioning the catheter into a desired locationwithin a patient's body lumen, expanding at least a portion of theopen-walled element, wherein the expanded portion of the open-walledelement contacts a wall of the lumen at a secured site thereby applyinga radially expanding securing force at the secured site sufficient tosecure the catheter in the lumen; and performing a medical procedure.Fluid, such as cardioplegic solution, can be delivered from the cannulamember to the patient's body lumen.

[0036] As described above, the open-walled element 12 is expanded whenthe member to which it is secured is extended beyond the distal end ofthe outer tubular member 16 or inner tubular member 17. With aself-expanding tubular open-walled element 12, the step of expanding atleast a portion of the open-walled element includes the step oflongitudinally separating the inner and outer tubular members so that atleast a distal portion of the open-walled element extends distally ofthe distal end of the outer tubular member. Where the tubularopen-walled element 12 is on the cannula member 18, the outer tubularmember 16 and cannula member 18 are longitudinally separated to extendthe open-walled element distally of the distal end of the outer tubularmember 16 of the shaft 11. With a tubular open-walled element 12 that isnot self-expanding, the step of expanding at least a portion of theopen-walled element includes the step of applying a radially expandingforce on the open-walled element so that the open-walled element expandsradially. To release the catheter from within the body lumen, thetubular open-walled element 12 is retracted into the outer tubularmember lumen or the inner tubular member lumen, depending on whether theopen-walled element 12 is on the inner tubular member 17 or the cannulamember 18, respectively.

[0037] In one example, illustrated in FIG. 9, the procedure isretroperfusion of the heart 30, and the lumen is a coronary sinus 31.The method comprises positioning at least a distal portion of theopen-walled element inside the coronary sinus before being expanded, sothat the expanded open-walled element applies the radially expandingsecuring force at an intersection of the coronary sinus 31 and a middlecardiac vein 32 without occluding fluid flow into or out of the middlecardiac vein. The occluding member is positioned inside the coronarysinus to occlude the coronary sinus. The cannula member 18 may belongitudinally displaced relative to the expanded tubular open-walledelement to position the perfusion ports 27 and occluding member 13 atthe desired location. The cardioplegia solution can then be deliveredout the cannula perfusion ports 27 for full retroperfusion of the heart30. A distal pressure port (not shown) can be provided to measure thepressure in the sinus. The cannula member 18 can be positioned by directinsertion into the right atrium 33, using palpation or a Doppler probeinside the cannula, to direct the cannula and locate the flow from thevenous sinus. Surgical insertion is generally accomplished by the use amalleable stylet. Alternatively, the cannula member 18 can be insertedpercutaneously over a guidewire. The guidewire is slidably received in aguidewire lumen which extends to a port in the distal end of thecannula. Fluoroscopy can be used to direct the cannula.

[0038] In another example, illustrated in FIGS. 10-12, the procedure isperfusion of the ascending aorta 36. The method comprises introducingthe catheter 10 in the aorta, and positioning the distal portion of theopen-walled element 12 in the aortic arch 37 at the supra aorticbranches 38 before expanding the open-walled element 12. The open-walledelement 12 is expanded to secure the catheter 10 within the aorta, sothat the expanded open-walled element 12 does not occlude fluid flowinto or out of the supra aortic branches 38. FIG. 10 illustrates acatheter 10 introduced by dissection of the ascending aorta 36, and FIG.11 illustrates a catheter 10 introduced percutaneously into theascending aorta 36. Because the occluding member 13 is positionedupstream to the supra aortic branches 38 to thereby prevent back flowinto the heart, the perfusion ports 27 on the cannula member 18 arelocated distally to the occluding member 13 when the catheter 10 isintroduced by dissection to deliver the solution to the supra aorticbranches 38. The perfusion ports 27 are located proximally to theoccluding member 13 when the catheter 10 is introduced percutaneously.

[0039] In the aortic cannula illustrated in FIGS. 11 and 12, the outertubular member 16 distal end may be provided with side ports 48, toallow flow across the perfusion ports 27 when the cannula member 18, theoccluding member 13, and open-walled element 12 are fully disposed inthe outer tubular member 16 lumen. In another embodiment of theinvention, the aortic cannula illustrated in FIGS. 10, 11, 12 isprovided with an anterograde solution infusion lumen 46 and port 47(FIG. 12) for anterograde cardioplegic injection in the aortic root, andfor venting the left ventricle and aortic root area after the surgery isconcluded. To restart the heart after surgery, the occluder is withdrawnwhile maintaining perfusion. This is achieved by positioning the outertubular member of the shaft over the occluding member and/or the tubularopen-walled member. In the embodiments illustrated in FIGS. 11 and 12,perfusion is maintained via the side port 48 in the outer tubularmember, which allows flow from the cannula ports 27 to the patient'sbody lumen despite the outer tubular member 16 being fully disposeddistally over the cannula ports 27. The anterograde port 47 would belocated proximally of the occluding member 13 on the aortic cannulaillustrated in FIG. 10, and distally of the occluding member 13 in thepercutaneous aortic cannula illustrated in FIG. 11.

[0040] In another example, illustrated in FIG. 13, the procedure is thetreatment of aneurysms in a segment of the aorta requiring positioningof a shunt that bypasses the segment to be treated 40. The catheter isintroduced into the descending aorta 39 and a pair of occluding members13 on the cannula member 18 are positioned on either end of the segmentto be treated 40. The tubular open-walled element 12 is expanded withinthe descending aorta 39 by longitudinally retracting the outer tubularmember 16 over the cannula member 18, to secure the cannula member 18within the descending aorta 39. The cannula member 18 has plurality ofperfusion ports 27, one group 41 located proximally to the proximaloccluding member 42 and a second group 43 located distally to the distaloccluding member 44. The cannula member 18 can be introduced proximal ordistal to the segment to be treated 40. Occlusion of the segment 40allows for its shunting and decompressing before the segment 40 isexposed. tubular open-walled element 12 is expanded within thedescending aorta 39 by longitudinally retracting the outer tubularmember 16 over the cannula member 18, to secure the cannula member 18within the descending aorta 39. The cannula member 18 has plurality ofperfusion ports 27, one group 41 located proximally to the proximaloccluding member 42 and a second group 43 located distally to the distaloccluding member 44. The cannula member 18 can be introduced proximal ordistal to the segment to be treated 40. Occlusion of the segment 40allows for its shunting and decompressing before the segment 40 isexposed.

[0041] While use of the catheter of the invention has been discussed interms of vascular procedures, nonvascular applications exist, includingbut not limited to, prolonged endotracheal intubation which avoids therisk of tracheal necrosis induced by long term balloon compression ofthe tracheal wall, and tracheo-esophageal fistula isolation. While theinvention has been described herein in terms of certain preferredembodiments, modifications and improvements may be made to the inventionwithout departing from the scope thereof.

[0042] While use of the catheter of the invention has been discussed interms of vascular procedures, nonvascular applications exist, includingbut not limited to, prolonged endotracheal intubation which avoids therisk of tracheal necrosis induced by long term balloon compression ofthe tracheal wall, and tracheo-esophageal fistula isolation. While theinvention has been described herein in terms of certain preferredembodiments, modifications and improvements may be made to the inventionwithout departing from the scope thereof.

What is claimed is:
 1. An intraluminal catheter, comprising: a) anelongated shaft having a lumen; b) a tubular open-walled element havinga lumen, being secured to the shaft, and being at least in partexpandable to an expanded diameter within a body lumen to contact a walldefining the body lumen and thereby releasably secure the catheterwithin the body lumen; and c) an elongated cannula member slidablydisposed within the lumen of the shaft and the lumen of the tubularopen-walled element.
 2. The intraluminal catheter of claim 1 wherein thetubular open-walled element includes openings allowing for flow offluids across a wall of the element.
 3. The intraluminal catheter ofclaim 1 wherein the cannula member is releasably secured to the shaft.4. The intraluminal catheter of claim 3 including an occluding member onthe cannula member for occluding the body lumen, wherein the cannula andoccluding member thereon are longitudinally displaceable relative to thetubular open-walled element.
 5. The intraluminal catheter of claim 1wherein the shaft comprises: a) an outer tubular member having aproximal end and a distal end, a port on the distal end, and a lumenextending therein; and b) an inner tubular member slidably received inthe lumen of the outer tubular member, having a proximal end and adistal end, a port on the distal end, and a lumen extending therein, andwherein a proximal end of the tubular open-walled element is secured toa distal section of the inner tubular member, and a distal end of theopen-walled tubular element is unsecured.
 6. The intraluminal catheterof claim 5 wherein the tubular open-walled element is configured toassume an unexpanded diameter in response to radially compressing forceof the outer tubular member, and the expanded diameter when the radiallycompressing force of the outer tubular member is removed.
 7. Theintraluminal catheter of claim 5 including an occluding member on thecannula member for occluding the body lumens wherein the cannula andoccluding member thereon are longitudinally displaceable relative to thetubular open-walled element.
 8. The intraluminal catheter of claim 7wherein the occluding member comprises a reversibly expandableprotruding collar.
 9. The intraluminal catheter of claim 8 wherein theoccluding member is configured to reversibly expand to occlude thepatient's body lumen when the occluding member extends distally of thedistal end of the outer tubular member.
 10. An intraluminal catheter,comprising: a) an elongated shaft having a lumen; b) an elongatedcannula member slidably disposed within the lumen of the shaft; c) atubular open-walled element with a proximal end secured to the cannulamember, which is at least in part expandable to an expanded diameterwithin a body lumen to contact a wall defining the body lumen andthereby releasably secure the catheter within the body lumen; and d) anoccluding member secured to the cannula for occluding the body lumen.11. An intraluminal catheter, comprising: a) an elongated shaft having alumen; b) a tubular open-walled element secured to the shaft, which isat least in part expandable to an expanded diameter within a body lumento contact the wall defining the body lumen and thereby releasablysecure the catheter within the body lumen; and c) an occluding memberslidably received within the lumen of the shaft of the intraluminalcatheter for occluding the body lumen.
 12. The intraluminal catheter ofclaim 11 wherein the occluding member is secured to the tubularopen-walled element.
 13. The intraluminal catheter of claim 11 whereinthe shaft comprises: a) an outer tubular member having a proximal endand a distal end, a port on the distal end, and a lumen extendingtherein; b) an inner tubular member slidably disposed in the lumen ofthe outer tubular member, having a proximal end and a distal end, a porton the distal end, and a lumen extending therein, and wherein thetubular open-walled element is secured to a distal section of the innertubular member.
 14. The intraluminal catheter of claim 13 including anelongated cannula member slidably disposed within the lumen of the innertubular member.
 15. The intraluminal catheter of claim 14 including atleast one port on a distal section of the outer tubular member.
 16. Amethod of performing a medical procedure, comprising the steps of: a)positioning a catheter within a patient's body lumen, the cathetercomprising an outer tubular member having a proximal end and a distalend and a lumen extending therein; an inner tubular member slidablyreceived in the lumen of the outer tubular member, having a proximal endand a distal end and a lumen extending therein; a tubular open-walledelement which is at least in part expandable to an expanded diameterwithin the body lumen, having a proximal end secured to the distal endof the inner tubular member, and a lumen extending therein; a cannulamember slidably disposed in the lumen of the inner tubular member andthe lumen of the tubular open-walled member, and releasably securable tothe inner tubular member; an occluding member on the distal end of thecannula member configured to reversibly occlude the body lumen when thecannula member extends distally of the distal ends of the inner andouter tubular members; b) expanding at least a portion of theopen-walled element, so that the expanded portion of the open-walledelement contacts a wall defining the body lumen thereby applying aradially expanding securing force at a secured site on the wallsufficient to secure the catheter in the lumen; and c) performing amedical procedure.
 17. The method of claim 16 including the step ofoccluding the body lumen by longitudinally extending the cannula memberout the distal ends of the outer tubular member and inner tubularmember.
 18. The method of claim 16 wherein the step of expanding atleast a portion of the tubular open-walled element includes the step oflongitudinally separating the inner and outer tubular members so that atleast a distal portion of the open-walled element extends distally ofthe distal end of the outer tubular member.
 19. The method of claim 18wherein the step of expanding at least a portion of the open-walledelement includes the step of applying a radially expanding force on theopen-walled element.
 20. The method of claim 16 further including thestep of releasing the catheter from the lumen by retracting theopen-walled element into the outer tubular member lumen.
 21. The methodof claim 16 further including delivering a solution from the cannulamember to the patient's body lumen.
 22. The method of claim 16, whereinthe procedure is retroperfusion of the heart and the lumen is a coronarysinus, including the steps of: a) positioning at least a distal portionof the open-walled element inside the coronary sinus before beingexpanded, so that the expanded open-walled element applies the radiallyexpanding securing force at an intersection of the coronary sinus and amiddle cardiac vein without occluding fluid flow into or out of themiddle cardiac vein; and b) positioning the occluding member inside thecoronary sinus to occlude the coronary sinus.
 23. The method of claim16, wherein the lumen is an ascending aorta, including the steps of: a)introducing the catheter by dissection of the ascending aorta; b)positioning the distal portion of the open-walled element in an aorticarch above the supra aortic branches before expanding the open-walledelement, wherein the expanded open-walled element does not occlude fluidflow into or out of the supra aortic branches: and c) positioning theoccluding member proximal to the supra aortic branches to therebyprevent back flow into the heart.
 24. The method of claim 16, whereinthe lumen is an ascending aorta, including the steps of: a) introducingthe catheter percutaneously in the femoral artery; b) positioning thedistal portion of the open-walled element in the aortic arch above thesupra aortic branches before expanding the open-walled element, whereinthe expanded open-walled element does not occlude fluid flow into or outof the supra aortic branches; and c) positioning the occluding memberproximal to the supra aortic branches to thereby prevent back flow intothe heart.
 25. The method of treating an aneurysm in a descending aortaof a patient by isolating a dissection and positioning of a shunt in thedescending aorta, comprising the steps of: a) introducing a catheterinto the descending aorta, the catheter comprising an outer tubularmember having a proximal end and a distal end and a lumen extendingtherein; a cannula member slidably received in the lumen of the outertubular member; a tubular open-walled element which is at least in partexpandable to an expanded diameter within a body lumen, having proximaland distal ends and a lumen extending therein wherein the proximal endis secured to the distal end of the cannula member; a distal occludingmember on the cannula member distal end and a proximal occluding memberlocated proximally of the distal occluding member, configured toreversibly occlude a lumen of the patient when the cannula memberextends distally of the distal end of the outer tubular member; and aplurality of perfusion ports on the cannula member in fluidcommunication with the cannula member lumen, located distally of thedistal occluding member and proximally of the proximal occluding member;b) longitudinally retracting the outer tubular member over the cannulamember, thereby occluding the descending aorta and expanding at least aportion of the open-walled element, so that the expanded portion of theopen-walled element contacts a wall defining the lumen thereby applyinga radially expanding securing force on the wall sufficient to secure thecannula member in the body lumen; and c) positioning a shunt in theisolated descending aorta.